|
CT PELVIS W/CONTRAST
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 72193 26
|
| Hospital Charge Code |
9727219301
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna of VT Commercial |
$158.65
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$123.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$123.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$141.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$140.28
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$133.60
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$133.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$155.31
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.95
|
| Rate for Payer: United Healthcare Commercial |
$158.65
|
|
|
CT PELVIS W/O CONTRAST
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 72192 26
|
| Hospital Charge Code |
9727219201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$69.54 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Aetna of VT Commercial |
$149.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$140.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$69.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$140.66
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$94.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$127.17
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.65
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$124.81
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$125.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.60
|
| Rate for Payer: Martins Point Health Care Commercial |
$70.65
|
| Rate for Payer: Multiplan Commercial |
$146.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.45
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$70.65
|
| Rate for Payer: United Healthcare Commercial |
$149.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.65
|
| Rate for Payer: United Healthcare VA CCN |
$70.65
|
|
|
CT PELVIS W/O CONTRAST
|
Facility
|
IP
|
$2,040.08
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
3527219201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,509.86 |
| Max. Negotiated Rate |
$1,938.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,938.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,509.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,509.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,734.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,713.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,632.06
|
| Rate for Payer: Cash Price |
$1,020.04
|
| Rate for Payer: Cigna Commercial |
$1,632.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,632.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,632.06
|
| Rate for Payer: Multiplan Commercial |
$1,897.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,734.07
|
| Rate for Payer: United Healthcare Commercial |
$1,938.08
|
|
|
CT PELVIS W/O CONTRAST
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
CPT 72192 26
|
| Hospital Charge Code |
9727219201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$48.62 |
| Max. Negotiated Rate |
$369.69 |
| Rate for Payer: Aetna of VT Commercial |
$147.58
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$369.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$50.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$369.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$68.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$78.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$78.47
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$78.47
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$76.51
|
| Rate for Payer: Martins Point Health Care Commercial |
$48.62
|
| Rate for Payer: Multiplan Commercial |
$146.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$48.62
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$48.62
|
| Rate for Payer: United Healthcare Commercial |
$74.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.62
|
| Rate for Payer: United Healthcare VA CCN |
$48.62
|
|
|
CT PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,040.08
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
3527219201
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$369.69 |
| Max. Negotiated Rate |
$1,938.08 |
| Rate for Payer: Aetna of VT Commercial |
$1,938.08
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$369.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$903.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$369.69
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,228.13
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,734.07
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,652.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$918.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,621.86
|
| Rate for Payer: Cash Price |
$1,020.04
|
| Rate for Payer: Cash Price |
$1,020.04
|
| Rate for Payer: Cigna Commercial |
$1,632.06
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,632.06
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,632.06
|
| Rate for Payer: Martins Point Health Care Commercial |
$918.04
|
| Rate for Payer: Multiplan Commercial |
$1,897.27
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,734.07
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$918.04
|
| Rate for Payer: United Healthcare Commercial |
$1,938.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$918.04
|
| Rate for Payer: United Healthcare VA CCN |
$918.04
|
|
|
CT PELVIS W/O CONTRAST
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 72192 26
|
| Hospital Charge Code |
9727219201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Aetna of VT Commercial |
$149.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$116.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$116.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$133.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$131.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$125.60
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$125.60
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$125.60
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$125.60
|
| Rate for Payer: Multiplan Commercial |
$146.01
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.45
|
| Rate for Payer: United Healthcare Commercial |
$149.15
|
|
|
CT PELVIS W/O & W/CONTRAST
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 72194 26
|
| Hospital Charge Code |
9727219401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$77.95
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$157.68
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$105.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$139.92
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Martins Point Health Care Commercial |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.20
|
| Rate for Payer: United Healthcare VA CCN |
$79.20
|
|
|
CT PELVIS W/O & W/CONTRAST
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 72194 26
|
| Hospital Charge Code |
9727219401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$167.20 |
| Rate for Payer: Aetna of VT Commercial |
$167.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$130.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$149.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$140.80
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$140.80
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$149.60
|
| Rate for Payer: United Healthcare Commercial |
$167.20
|
|
|
CT PELVIS W/O & W/CONTRAST
|
Facility
|
OP
|
$3,347.37
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
3527219401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$772.63 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,482.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$2,015.12
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,845.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,711.37
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,506.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,661.16
|
| Rate for Payer: Cash Price |
$1,673.68
|
| Rate for Payer: Cash Price |
$1,673.68
|
| Rate for Payer: Cigna Commercial |
$2,677.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,677.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,677.90
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,506.32
|
| Rate for Payer: Multiplan Commercial |
$3,113.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,845.26
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,506.32
|
| Rate for Payer: United Healthcare Commercial |
$3,180.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,506.32
|
| Rate for Payer: United Healthcare VA CCN |
$1,506.32
|
|
|
CT PELVIS W/O & W/CONTRAST
|
Facility
|
IP
|
$3,347.37
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
3527219401
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,477.39 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna of VT Commercial |
$3,180.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,477.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,477.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,845.26
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,811.79
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,677.90
|
| Rate for Payer: Cash Price |
$1,673.68
|
| Rate for Payer: Cigna Commercial |
$2,677.90
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,677.90
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,677.90
|
| Rate for Payer: Multiplan Commercial |
$3,113.05
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,845.26
|
| Rate for Payer: United Healthcare Commercial |
$3,180.00
|
|
|
CT PELVIS W/O & W/CONTRAST
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 72194 26
|
| Hospital Charge Code |
9727219401
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$772.63 |
| Rate for Payer: Aetna of VT Commercial |
$165.44
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$56.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$772.63
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$76.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$90.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$90.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$62.59
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$90.14
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$85.18
|
| Rate for Payer: Martins Point Health Care Commercial |
$54.43
|
| Rate for Payer: Multiplan Commercial |
$163.68
|
| Rate for Payer: MVP Health Care of NY Commercial |
$54.43
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$54.43
|
| Rate for Payer: United Healthcare Commercial |
$83.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.43
|
| Rate for Payer: United Healthcare VA CCN |
$54.43
|
|
|
CT SOFT TISSUE NECK W/CONTRAST
|
Facility
|
OP
|
$2,260.32
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
3507049101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$538.56 |
| Max. Negotiated Rate |
$2,147.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,147.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,001.10
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,360.71
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,921.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,830.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,017.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,796.95
|
| Rate for Payer: Cash Price |
$1,130.16
|
| Rate for Payer: Cash Price |
$1,130.16
|
| Rate for Payer: Cigna Commercial |
$1,808.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,808.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,808.26
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,017.14
|
| Rate for Payer: Multiplan Commercial |
$2,102.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,921.27
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,017.14
|
| Rate for Payer: United Healthcare Commercial |
$2,147.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,017.14
|
| Rate for Payer: United Healthcare VA CCN |
$1,017.14
|
|
|
CT SOFT TISSUE NECK W/CONTRAST
|
Facility
|
IP
|
$2,260.32
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
3507049101
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,672.86 |
| Max. Negotiated Rate |
$2,147.30 |
| Rate for Payer: Aetna of VT Commercial |
$2,147.30
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,672.86
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,672.86
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,921.27
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,898.67
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,808.26
|
| Rate for Payer: Cash Price |
$1,130.16
|
| Rate for Payer: Cigna Commercial |
$1,808.26
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,808.26
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,808.26
|
| Rate for Payer: Multiplan Commercial |
$2,102.10
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,921.27
|
| Rate for Payer: United Healthcare Commercial |
$2,147.30
|
|
|
CT SOFT TISSUE NECK W/CONTRAST
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 70491 26
|
| Hospital Charge Code |
9727049101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna of VT Commercial |
$235.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$183.54
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$183.54
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$208.32
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$198.40
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.40
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.80
|
| Rate for Payer: United Healthcare Commercial |
$235.60
|
|
|
CT SOFT TISSUE NECK W/CONTRAST
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 70491 26
|
| Hospital Charge Code |
9727049101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$61.70 |
| Max. Negotiated Rate |
$538.56 |
| Rate for Payer: Aetna of VT Commercial |
$233.12
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$538.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$63.55
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$538.56
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$86.38
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$101.93
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$70.95
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$101.93
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$97.16
|
| Rate for Payer: Martins Point Health Care Commercial |
$61.70
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$61.70
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$61.70
|
| Rate for Payer: United Healthcare Commercial |
$94.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.70
|
| Rate for Payer: United Healthcare VA CCN |
$61.70
|
|
|
CT SOFT TISSUE NECK W/CONTRAST
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 70491 26
|
| Hospital Charge Code |
9727049101
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna of VT Commercial |
$235.60
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$222.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$109.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$222.18
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$149.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$210.80
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$200.88
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$197.16
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$198.40
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$198.40
|
| Rate for Payer: Martins Point Health Care Commercial |
$111.60
|
| Rate for Payer: Multiplan Commercial |
$230.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$210.80
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$111.60
|
| Rate for Payer: United Healthcare Commercial |
$235.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.60
|
| Rate for Payer: United Healthcare VA CCN |
$111.60
|
|
|
CT SOFT TISSUE NECK W/O CONTR
|
Facility
|
OP
|
$1,848.92
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
3507049001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$405.84 |
| Max. Negotiated Rate |
$1,756.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,756.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$405.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$818.89
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$405.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,113.05
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,571.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,497.63
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$832.01
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,469.89
|
| Rate for Payer: Cash Price |
$924.46
|
| Rate for Payer: Cash Price |
$924.46
|
| Rate for Payer: Cigna Commercial |
$1,479.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,479.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,479.14
|
| Rate for Payer: Martins Point Health Care Commercial |
$832.01
|
| Rate for Payer: Multiplan Commercial |
$1,719.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,571.58
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$832.01
|
| Rate for Payer: United Healthcare Commercial |
$1,756.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$832.01
|
| Rate for Payer: United Healthcare VA CCN |
$832.01
|
|
|
CT SOFT TISSUE NECK W/O CONTR
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 70490 26
|
| Hospital Charge Code |
9727049001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$101.87 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna of VT Commercial |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$101.87
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$206.06
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$182.85
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.50
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$103.50
|
| Rate for Payer: United Healthcare Commercial |
$218.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.50
|
| Rate for Payer: United Healthcare VA CCN |
$103.50
|
|
|
CT SOFT TISSUE NECK W/O CONTR
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 70490 26
|
| Hospital Charge Code |
9727049001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$170.22 |
| Max. Negotiated Rate |
$218.50 |
| Rate for Payer: Aetna of VT Commercial |
$218.50
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$170.22
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$195.50
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$193.20
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$184.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$184.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$184.00
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$195.50
|
| Rate for Payer: United Healthcare Commercial |
$218.50
|
|
|
CT SOFT TISSUE NECK W/O CONTR
|
Facility
|
IP
|
$1,848.92
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
3507049001
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,368.39 |
| Max. Negotiated Rate |
$1,756.47 |
| Rate for Payer: Aetna of VT Commercial |
$1,756.47
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$1,368.39
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$1,368.39
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$1,571.58
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$1,553.09
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$1,479.14
|
| Rate for Payer: Cash Price |
$924.46
|
| Rate for Payer: Cigna Commercial |
$1,479.14
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$1,479.14
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$1,479.14
|
| Rate for Payer: Multiplan Commercial |
$1,719.50
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,571.58
|
| Rate for Payer: United Healthcare Commercial |
$1,756.47
|
|
|
CT SOFT TISSUE NECK W/O CONTR
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
CPT 70490 26
|
| Hospital Charge Code |
9727049001
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$405.84 |
| Rate for Payer: Aetna of VT Commercial |
$216.20
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$405.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$59.24
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$405.84
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$80.51
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$66.14
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$94.81
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$90.03
|
| Rate for Payer: Martins Point Health Care Commercial |
$57.51
|
| Rate for Payer: Multiplan Commercial |
$213.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.51
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$57.51
|
| Rate for Payer: United Healthcare Commercial |
$88.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.51
|
| Rate for Payer: United Healthcare VA CCN |
$57.51
|
|
|
CT SOFT TISSUE NECK W/O &W/DYE
|
Facility
|
OP
|
$2,790.77
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
3507049201
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$655.57 |
| Max. Negotiated Rate |
$2,651.23 |
| Rate for Payer: Aetna of VT Commercial |
$2,651.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$655.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$1,236.03
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$655.57
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$1,680.04
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,372.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,260.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$1,255.85
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,218.66
|
| Rate for Payer: Cash Price |
$1,395.38
|
| Rate for Payer: Cash Price |
$1,395.38
|
| Rate for Payer: Cigna Commercial |
$2,232.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,232.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,232.62
|
| Rate for Payer: Martins Point Health Care Commercial |
$1,255.85
|
| Rate for Payer: Multiplan Commercial |
$2,595.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,372.15
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$1,255.85
|
| Rate for Payer: United Healthcare Commercial |
$2,651.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,255.85
|
| Rate for Payer: United Healthcare VA CCN |
$1,255.85
|
|
|
CT SOFT TISSUE NECK W/O &W/DYE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 70492 26
|
| Hospital Charge Code |
9727049201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$192.43 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna of VT Commercial |
$247.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$192.43
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$218.40
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$208.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.00
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.00
|
| Rate for Payer: United Healthcare Commercial |
$247.00
|
|
|
CT SOFT TISSUE NECK W/O &W/DYE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 70492 26
|
| Hospital Charge Code |
9727049201
|
|
Hospital Revenue Code
|
972
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna of VT Commercial |
$247.00
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$232.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Qualified Health Plan |
$115.15
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$232.93
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP On Exchange |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$221.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$210.60
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Medicare Advantage |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$206.70
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$208.00
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$208.00
|
| Rate for Payer: Martins Point Health Care Commercial |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$241.80
|
| Rate for Payer: MVP Health Care of NY Commercial |
$221.00
|
| Rate for Payer: MVP Health Care of NY Medicare Advantage |
$117.00
|
| Rate for Payer: United Healthcare Commercial |
$247.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.00
|
| Rate for Payer: United Healthcare VA CCN |
$117.00
|
|
|
CT SOFT TISSUE NECK W/O &W/DYE
|
Facility
|
IP
|
$2,790.77
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
3507049201
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,065.45 |
| Max. Negotiated Rate |
$2,651.23 |
| Rate for Payer: Aetna of VT Commercial |
$2,651.23
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire Commercial |
$2,065.45
|
| Rate for Payer: Blue Cross Blue Shield of New Hampshire SHOP Off Exchange |
$2,065.45
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Commercial |
$2,372.15
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Managed Care |
$2,344.25
|
| Rate for Payer: Blue Cross Blue Shield of Vermont Vermont Health Plan |
$2,232.62
|
| Rate for Payer: Cash Price |
$1,395.38
|
| Rate for Payer: Cigna Commercial |
$2,232.62
|
| Rate for Payer: Harvard Pilgrim Health Care HMO |
$2,232.62
|
| Rate for Payer: Harvard Pilgrim Health Care PPO |
$2,232.62
|
| Rate for Payer: Multiplan Commercial |
$2,595.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,372.15
|
| Rate for Payer: United Healthcare Commercial |
$2,651.23
|
|
